Discovering Cultural Aspects of Nurse-Patient Relationships
Kleiman, Susan, Journal of Cultural Diversity
Abstract: The purpose of this article is to illuminate modes of inquiry that unconceal cultural aspects of the meaningful life-world of individuals. To present strategies for acquiring cultural awareness, sensitivity, and competence based on insights gained from these modes of inquiry. Conclusion: Nurses can acquire and implement culturally competent patient care by inquiring into individual's personal interpretations of their life's world experiences rather than relying on catalogs of cultural attributes or by adhering to popularly held opinions. By following the procedures for augmenting culturally competent nursing outlined in this article nurses reported being able to provide a more culturally competent, higher quality of patient care.
Key Words: Cultural Awareness, Cultural Sensitivity, Cultural Competence, Modes of Inquiry, and Life-world
The growing diversity among populations in large metropolitan areas, as well as a similarly diverse health care community, gives rise to a need for awareness and knowledge about the extent to which individuals in given situations are influenced by culturally inhered values and meanings. This mandate is particularly relevant in nursing because recognition and respect for one's culturally derived meanings and attitudes effect the quality of patient care (Heller, Oros, & Durney-Crowley, 2000; Leininger, 2001; Ludwig and Silva, 2000; National League for Nursing, 2002). According to reports in Healthy People 2010 (2000), sensitivity to culturally inherent meanings of individuals is an obligation of health care providers that facilitates the delivery of high quality care and enhances patient outcomes. In order for nurses to fully appreciate the influence of culture they must be able to recognize and acknowledge how culture impacts on themselves as people and as nurses.
What is Culture?
Culture may be taken as including all the characteristics of the everyday lives of a people. These characteristics become markers by which cultural assignments are made, and include traditions, social organizations, language, and values and beliefs that are the expression of a particular group of people. In this article, I distinguish between aspects of culture and aspects of nature in order to focus attention on social and mental constructs, e.g., language, traditions, and manifestations of emotional responses to situations (Levi-Strauss, 1983).
Cultural Attributes of Individuals
Individuals display cultural affinities that originate and evolve from past histories; however, each person interprets the meanings, values, and beliefs which serve to define his or her personhood and his or her own life's world. These personal interpretations give us insight into perceptions of the world that have accumulated in past consciousness as well as reflecting the urgency or the moment (Gadamer, 1989). Because of this dual dynamic, each interpretation or re-interpretation has a degree of freshness that includes moments that are quite unexpected and unfamiliar.
We therefore must use caution tempered with a bit of skepticism when we attempt to extrapolate past observations of behaviors of classes or groups of people. It is imprudent and insensitive to assume that one can automatically assign attributes and popularly accepted beliefs to individual patients.
An example of this is the phrase, "African American," and the social, political, economic, and linguistic connotations it carries. In a class of undergraduate students, I used this phrase and was immediately taken to task by a student who indignantly pointed out that she did not consider herselfAfrican American, but rather "Black." Several other students chimed in adding that while they did have distant roots in Africa, they were, by no means of American heritage. They complained that the frequently used designation "African American" which they assumed was based on their skin color is misleading as to their true heritage, e. …